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Evaluation of the Direct Antiglobulin (Coombs') Test for Identifying Newborns at Risk for Hemolysis as Determined by End-Tidal Carbon Monoxide Concentration (ETCOc); and Comparison of the Coombs' Test With ETCOc for Detecting Significant Jaundice

Journal of Perinatology volume 22, pages 341–347 (2002)Cite this article

Abstract

OBJECTIVE: First, to determine the sensitivity, specificity, and positive predictive value (PPV) of the direct antiglobulin test (DAT) for significant hemolysis in the neonate, as referenced to end-tidal carbon monoxide, the criterion standard for estimating the rate of hemolysis; and second, to evaluate the predictive value of the two procedures for significant jaundice.

DESIGN: Consecutive term newborns admitted to the nursery of an inner-city university hospital over a 15-week period. DAT screening by the Blood Bank was performed on all. End-tidal carbon monoxide levels were obtained at 12±6 and at 24±6 hours of age. Infants of nonsmoking mothers whose 12-hour exhaled carbon monoxide level was ≥95th percentile were defined as having significant hemolysis.

RESULTS: n=660; DAT was positive in 23 (3.5%). Using the 12-hour end-tidal carbon monoxide ≥3.2 μl/l (≥95th percentile) as reference (n=499 nonsmokers), the sensitivity of the DAT was 38.5% (10 of 26) and specificity 98.5% (466 of 473) for the detection of significant hemolysis. The PPV of the DAT for significant hemolysis at 12 hours was 58.8% (10 of 17). For significant jaundice the PPV of end-tidal carbon monoxide was greater than that for DAT (65.4% vs 52.9%), although not statistically so (p=0.25). The negative predictive values were similar.

CONCLUSION: DAT fails to identify over half of the cases of significant hemolysis that are diagnosed by end-tidal carbon monoxide. A neonate with a positive DAT has about a 59% chance of having significant hemolysis. End-tidal carbon monoxide may also provide a more sensitive index for predicting significant jaundice.

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Acknowledgements

This study was supported by a grant and equipment from Natus Medical. The authors thank Linda Mack, RN, for her invaluable help with the data collection. We also thank Hector L. Hernandez for his conscientious assistance with the case report forms; and Chris Chung, MD, for his thoughtful contributions. We are grateful to Herbert T. Abelson, MD, for his helpful review of the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, The University of Chicago, Chicago, IL, USA

    Marguerite Herschel MD & Leslie Caldarelli MD

  2. Department of Health Studies, The University of Chicago, Chicago, IL, USA

    Theodore Karrison PhD & Ming Wen MS

  3. Department of Pathology, The University of Chicago, Chicago, IL, USA

    Beverly Baron MD

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Herschel, M., Karrison, T., Wen, M. et al. Evaluation of the Direct Antiglobulin (Coombs') Test for Identifying Newborns at Risk for Hemolysis as Determined by End-Tidal Carbon Monoxide Concentration (ETCOc); and Comparison of the Coombs' Test With ETCOc for Detecting Significant Jaundice. J Perinatol 22, 341–347 (2002). https://doi.org/10.1038/sj.jp.7210702

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